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Is the False Claims Act of 1986 Still Relevant Today?

false claims act of 1986

false claims act of 1986Are you trying to get your facts straight about the False Claims Act of 1986? Keep reading to get the information you need to know.

The False Claims Act of 1986 is an amendment to the original False Claims Act, which dates back to Civil War days when suppliers to the Union Army were defrauding the US government. The law was created to entice people to bring the criminals to the attention of the government so the prosecution could take place.

In the original writing, the act allowed the person reporting the fraud to receive 50% of the amount recovered. It also permitted anyone to bring a case forward, under what is known as the qui tam provision. Qui tam comes from a Latin term and roughly means to bring a suit on behalf of the king, as well as himself. Any private citizen aware of a fraud could bring a suit. If the fraud was proven, the defendant was required to pay double the amount of the fraud, plus a fine of $2,000 per claim.

Many old laws become obsolete, even though they remain on the books. In Gainesville, Georgia, for example, it is illegal to eat fried chicken in any way other than with your hands. Yes, you read that right! While the original False Claims Act wasn’t so silly, it did become just as ignored and irrelevant. As years went by, the Act remained in effect, but it was mostly ignored.

The first amendment to the law came in 1945, which set up huge barriers for people who wanted to bring a suit, because it eliminated nearly any reward they would receive. This change removed all incentive and ability for a private citizen to bring a whistleblowing suit. The amendment also disallowed anyone from filing qui tam suits if the government had a tip at all about the reported situation, even if it was not under investigation.

The False Claims Act was virtually dead in the water after this change.

How Was the False Claims Act Changed in 1986?

In 1986, it came to light that many defense contractors were bilking the federal government out of millions of dollars through fraudulent billing. It became public knowledge that the government was paying tens of thousands of dollars for mundane items such as light bulbs, hammers, and toilet seats.

Congress responded by revamping the old False Claims Act, once known as the Lincoln Laws, in 1986, bringing the law into current relevancy and increasing protection against retaliation for the people who reported the fraud. Because of these amendments, a resurgence of the law’s use took place.

When Congress amended the False Claims Act in 1986, the main changes involved increasing the penalties against those who commit fraud against the government, as well as raising the amount of the rewards the person reporting the acts could receive. This new award reinstated the incentive for people to report known fraud.

The 1986 amendment also increased the amount of the penalties assessed to those guilty of fraudulent charges. The punishment was increased to three times the amount of the money illegally taken. Also, damages increased to a minimum of $5,000 and a maximum of $10.000 per each separate claim. The reward for the whistleblowers now provides them from 15% to 30% of the recovered money. The defendant also pays the fees for the whistleblower’s attorney, at their regular rate.

The other significant change in the 1986 amendment was that the offenders could be held liable for acting in “reckless disregard” of the truth or in “deliberate ignorance.” This change brought the power of the False Claims Act back into play.

Is the False Claims Act Amendment of 1986 Relevant Today?

Absolutely. In fact, the False Claims Act, with the amendments of 1986, is the single most useful tool the federal government has in the fight against fraud. While further modifications to the act came in 2009 and 2010, these amendments expanded the definitions of liability and also increased the ability of the government to investigate claims.

The government has recovered over $48 billion since the 1986 amendments to the False Claims Act. More than half of that amount has come through whistleblowers’ actions. There has been more than $5.3 billion paid out in rewards to people who have brought qui tam suits to the US District Court.

You need to have a lawyer who understands the complexities of the False Claims Act and its subsequent amendments and protections to present a substantial and qualified case to court. If you are aware of fraud in your workplace or elsewhere, the time to step forward is now.

To learn more about the False Claims Act of 1986, get in touch with our experienced legal team at Bothwell Law Group online.

How Does Legal Representation Work in a Medicare Whistleblower Case?

Medicare Whistleblower Case

Medicare Whistleblower CaseIf you’re thinking of filing a Medicare whistleblower case, you’re not alone. Every year, billions of dollars (yes, that’s billions with a B) are spent on false medical claims. Whether the source is inadequate care, illegal kickbacks, or overcharging for goods and services, the scope of fraud is frankly astronomical. In fact, one government audit estimated as much as 10% of Medicare charges are fraudulent!Medicare Whistleblower Case

Common Types of Medicare Fraud

In case you are wondering what qualifies as “fraudulent,” here is a list of some of the most common forms you might come across in any medical practice:

  • Double Billing: Billing for the same service more than once.
  • Fake/Phantom Charges: Charging for services that were never performed.
  • Up Charging: Billing for expensive equipment and testing when inferior items were actually used.
  • Co-payment Comps: Rolling required co-pays into the bill under false charging categories.
  • Kickbacks: Receiving a benefit from a company or lab in exchange for using them exclusively, or more than others.

And the list goes on and on. Every year, people find new ways to attempt to defraud the Medicare program. The government must rely on good citizens to turn in the fraudsters, blowing the whistle on illegal activities. This is the heart of the False Claims Act.

Filing a Whistleblower Suit…Or Not

Once you become aware of any fraudulent activity against the government, the first thing you should do is stay quiet and hire a lawyer. Be sure to do some research, and interview a few firms. This is incredibly important as your lawyer will be a vital part of your success, and determining the size of reward you may be eligible to receive.

Once your attorney has reviewed the case, they can advise you on the best course of action. In some instances, it may be in your best interest NOT to file suit. Your lawyer should explain the possible outcomes, ramifications, and the likelihood of success so you can make an educated decision.

If you do decide to proceed, you will be filing as a private citizen acting in the interest of the government, to recover funds on their behalf. You may or may not need to cover attorney fees accumulated up to this point; be sure and ask about the billing and settlement process during the interview phase.

Government Review of Medicare Fraud Suits

Your lawsuit will be filed in secret (AKA “under seal”), and only you, your attorney, and the government will be aware it exists. The government has this opportunity to review all the facts, findings, and proof contained in your supporting documents. Based on the strength of the case, the government then chooses whether or not to join your case, or intervene.

Government Intervention for Whistleblower Lawsuits

If the government joins, they take over pursuit of the case, working with your lawyer to hand it off to their attorneys. This is a good thing, as cases where the government intervenes have a much higher success rate. Your payout is then determined at the end of the trial, and most of your attorney fees are likely covered through the payout.

If the government doesn’t intervene, then you have to choose whether to push forward or not. Your share of the payout will be higher if you succeed, but if the lawsuit fails, you may be liable for all your attorney fees.

Looking for More Information on Whistleblower Legal Representation?

Contact the skilled Medicare whistleblower case attorneys at Bothwell Law Group by calling 770.643.1606 today.

What Is Medicare Billing Fraud?

Medicare Billing Fraud

Medicare Billing FraudEven if you are highly familiar with Medicare, it may not be easy to spot Medicare billing fraud. Medicare is an insurance program provided by the federal government to individuals who are 65 years old or older. Additionally, young people with qualifying disabilities and individuals with end-stage renal disease may qualify for Medicare coverage.

What Is Medicare Billing Fraud?

Medicare fraud occurs when a healthcare provider gives false information to Medicare. As a result, the provider receives additional compensation beyond what is appropriate. In some cases, this may be as obvious as billing for a service never received. In other cases, such as unbundling a service in order to bill at a higher rate, the Medicare fraud is inconspicuous.

If you are the employee of a healthcare facility who receives Medicare compensation, it is important to always keep an eye out for any behavior that qualifies as Medicare fraud. If you are a recipient of services paid for by Medicare insurance, you can also play a role in reporting fraud. The False Claims Act indicates fraudulent activity can come in many forms, but with enough knowledge you can quickly spot a healthcare scam and become a whistleblower.

Examples of Medicare Billing Fraud

Medicare billing fraud can take on many different forms. In each circumstance, fraud always has one thing in common—medical information is being misrepresented and government funds are being misused as a result. Here are a few examples that qualify as Medicare billing fraud:

  • A physician bills for a service, but the patient never received that service.
  • A medical supply distributor submits for reimbursement for supplies never received by the person covered under Medicare.
  • A false diagnosis is documented, allowing the healthcare provider to receive compensation for more expensive services or supplies.
  • A group of services that are normally billed as one, such as a complete blood count, is unbundled into individual services, resulting in higher compensation.
  • A medication is prescribed after the physician receives kickbacks from the company producing the medication.
  • A test or procedure is upcoded, or billed as a more expensive service.

The Cost of Medicare Billing Fraud

When Medicare billing fraud occurs, government funds set aside for providing healthcare services for individuals over 65, young people with certain disabilities, or end-of-life conditions are improperly used. Loss of government funds is not the only consequence created by fraudulent behavior; it causes healthcare costs to rise for everyone in the United States.

If you suspect a healthcare provider of Medicare billing fraud, you can become a whistleblower. Your cooperation will not only play a role of reducing the occurrences of fraud within the healthcare system, you may also be rewarded. Under the False Claims Act, whistleblowers may receive as much as 25 percent of the recovered government funds resulting from the lawsuit. Without an attorney, you do not qualify for the rewards outlined by the False Claims Act and you cannot be protected from retaliation.

To learn more about becoming a Medicare fraud whistleblower, call 770.643.1606 to speak an experienced attorney at Bothwell Law Group.